Prognosis of advanced stage non-small cell lung cancer: Is it different in patients with chronic obstructive pulmonary disease?

Objective: To investigate the clinical features and the prognosis of patients with advanced staged non-small cell lung cancer (NSCLC) complicated by chronic obstructive pulmonary disease (COPD). Material and methods: We retrospectively analyzed the data of patients with newly diagnosed NSCLC complicated by COPD at the pulmonary clinic of an university hospital between March, 2009 and May, 2013. The clinical data included history of smoking, pulmonary function test results, initial treatments, tumor node and metastasis (TNM) stage, comorbidities and laboratory tests. The Cox proportional hazards regression model was used to explore the prognostic factors in these patients. Results: A total of 137 NSCLC patients were investigated, of which 61 (44.5%) patients had the co-morbidity of COPD as confirmed by spirometry using bronchodilator test and 76 (55.5%) patients grouped as non COPD. Twenty (14.6%) patients had stage IIIA, 27 (19.7%) had stage IIIB, 90 (65.7%) had stage IV. The COPD group had fewer never-smokers than the non-COPD group (p=0.028). There was no significant difference in overall survival between COPD and non-COPD groups (9.8 and 10.9 months, log-rank test p=0.445). In the multivariate Cox's proportional hazard model, the hazard ratio (HR) was statistically significant for TNM stage (HR=1.7, 95% CI: 1.2-2.7; p=0.002), but not for the presence of COPD (HR=0.89, 95% CI: 0.86-1.1; p=0.543). Conclusion: In patients with advanced stage NSCLC, COPD did not have a significant deleterious impact on prognosis of patients.